Over one million patients at risk of not receiving treatment every year due to anaesthetic workforce shortages

Published: 22/11/2020

COVID-19 has shone a light on the pressures faced by anaesthetists

Anaesthetists are front-and-centre of managing the sickest COVID-19 patients in high risk environments and critical to the restoration of normal surgical services

The Royal College of Anaesthetists (RCoA) has today released its Medical Workforce Census Report 2020, showing on-going and significant workforce gaps in the service. The RCoA is warning that data gathered from 97% of NHS hospital Boards and Trusts shows that more than one million surgical procedures1 will need to be delayed every year unless anaesthetic workforce numbers are increased to meet patient demand.2

As NHS hospitals face a perfect storm of significant anaesthetic staff shortages with 90% of hospitals having consultant vacancies, coupled with rising cases of COVID-19, it is non-COVID patients and the elective care they should be receiving which is being impacted.

To address this situation, the RCoA is again calling on the Government to invest in anaesthetic training places, packaged within a sustainable, long-term approach to the funding of medical training places in the UK. The RCoA is currently working to define the number of anaesthetists needed over the next five year period and calls on the Government to work with them and stakeholders to fill these anaesthetic workforce gaps, so NHS patients can receive the hospital care wherever and whenever they need it.

The consequences of continuing to under invest in NHS staff will leave anaesthetists – who care for more than two-thirds of all NHS hospital patients and who have had a central role on the frontline during COVID-19 – continuing to struggle to provide full surgical services alongside any future pandemics.

Anaesthesia is the single largest hospital specialty, on which over three million3 patients rely each year. The UK anaesthetic workforce therefore needs to be placed on a more sustainable footing to enable it to safely meet the growing demand for healthcare services from an ageing population and the increasing complexity of patients’ multi-morbidities, while also being supported to meet the additional pressures of future pandemics.

The 2020 College Census key figures show:

  • 90% of NHS anaesthetic departments have at least one funded consultant vacancy
  • 680 funded but vacant consultant posts, representing 8% of the workforce a rise from 4.4% in 2015
  • 243 funded but vacant SAS doctor posts
  • a 1,054 funded and aspirational4 consultant gap (11.8%)
  • an ageing anaesthetic workforce – the number of consultants who now work beyond 60 and approaching retirement has increased from 5% in 2015 to 7% in 2020
  • 39% of consultants are now over 50, an increase from 31% in 2007 
  • 1,133 consultants have reduced their programmed hours due to pension tax changes, representing 14% of the consultant workforce.

Growth of the consultant workforce is significantly lower than needed to meet patient demand and the stagnation in the number of SAS doctors since 2015 only increases the likelihood of delayed treatment.  The ability of anaesthetic departments to recruit anaesthetists to meet local demands are directly dependent and limited by the supply of newly qualified anaesthetists coming through specialist training. While approximately 4,000 anaesthetists in training should successfully complete their training over the next five to eight years, demand continues to grow at a faster pace, leading to a predicted increasing workforce gap over the coming years. The effect of anaesthetists in training abandoning a career in anaesthesia must also be taken into consideration. RCoA analysis in 2015 showed then that the attrition rate for anaesthetists in training was in the order of 25%5.

Professor Ravi Mahajan, President of the Royal College of Anaesthetists said:

“In the UK and globally, anaesthetists have demonstrated their leadership skills in teaching and training and in supporting colleagues in intensive care units and wards. Anaesthetists have been vital to governments across the world in the development of new technologies and treatments to help care for the millions of COVID patients requiring our specialist care. This global pandemic has shown that there has never been a greater need for trained anaesthetists, and now, as a significant number of countries are entering second surges of this terrible virus, is the time for us to focus on this need.

“Investment in anaesthetic training capacity is essential to keep this critical hospital service safe. I am incredibly proud of the work of anaesthetists and all other healthcare professionals across the NHS who have sacrificed so much. We owe them all a huge debt of gratitude, so I call on the government to recognise and work with us to address this growing need.

“As we look to the future, it is more important than ever to recognise that a sustainable health and care workforce is necessary to deliver the NHS People Plan for 2020/21. While we welcomed the government’s £3.7B of capital funding for hospital development earlier this year, we re-iterate our call for investment in the training of qualified staff to work in those places.”


The Royal College of Anaesthetists ran the Medical Workforce Census Report 2020 from 6 January to 6 March. Data was gathered from 97% of NHS hospital Boards and Trusts.  


  1. 1,410 Consultant (1,054) and SAS (356) anaesthetists are required to fill current workforce gaps. (RCoA Medical Workforce Census Report 2020, November 2020). The average anaesthetist across all grades treats 750 patients per year
  2. Based on anaesthetists not working above and beyond contracted hours 
  3. British Journal of Anaesthesia, Frequency of surgical treatment and related hospital procedures in the UK, July 2017 
  4. Number of anaesthetists Clinical Directors say they need in addition to the funded posts to cover the entire service
  5. RCoA. Workforce Data Pack 2018. March 2018